Healthcare settings and providers are often portrayed in television and film, which can contribute to discussions of pertinent concerns in real practice. Since nurses play such an essential role throughout the care experience for patients, nurses must be knowledgeable about and realize these issues, including ethics and legalities, directly affect them and their work. The film Wit can help to guide conversations regarding appropriate patient care for both nurses and other providers. Several notable components in Wit will be discussed, along with the ethical, legal, and nursing implications for each.
Specifically, the movie raises questions about issues regarding autonomy, advocacy, empathy, and mortality.
Wit illustrates a lack of autonomy and patient-centered care that is exemplified by paternalistic behavior in its physicians, namely Dr. Kelekian. In the opening scenes of the movie, Dr. Kelekian newly diagnoses Vivian Bearing with Stage IV ovarian cancer, and a few beats later he states that it is essential for Vivian to undergo the full dose of chemotherapy, inquiring if she can be “tough” and maintain her resolve to withstand her treatments.
Rather than allowing Vivian sufficient time to ponder over the information and voice concerns, Dr. Kelekian rushes through this consultation while pressuring his patient to follow through with his recommendation. Vivian, unable to process this delivery of shocking news and reeling from unknown medical jargon, signs the informed consent form and does not ask any questions. Paternalism once held a place in medical practice; however, the patient-centered care model of the modern-day has taken its place, focusing on patient autonomy and informed consent.
The AMA (American Medical Association) stated in 1847 that the patient should adhere to the physician’s medical advice unquestionably and obediently (McCoy, 2008, p. 786). Even though the number of unneeded treatments and procedures in the United States is 7.5 million every year, a current AMA policy explains that the physician should actively collaborate with his or her patient and that the patient has the right to accept, decline, inquire and make a decision regarding their provider’s advice. Physicians and their patients should foster a trusting relationship that allows for autonomy, informed decision-making, effective teaching strategies, and partnership of power to make the best choice about care for the individual patient and their unique needs (McCoy, 2008, p. 786).
A plethora of nursing implications specifically exists for patient-centered care and autonomy, as nurses can be at the bedside or serve as advanced-practice providers, such as nurse practitioners. In Vivian’s case, her oncology nurse, Suzie, aims to provide patient-centered care by ensuring that Vivian’s psychosocial and physical needs come before her role in the experimental research protocol of cancer treatment. Like Suzie in the film, nurses will be asked by the patient to give their thoughts on treatment options, be expected to explain details of the illness, and support the patient in this difficult process (Tariman et al., 2016, p. 560). Registered Nurses (RNs) are held liable for witnessing and documenting informed consent taking place and can be penalized legally for not sharing a lack of informed consent with providers (Rich, 2016, p. 38). Advanced-practice nurses can serve as the main provider; therefore, they are legally bound to obtain informed consent and explain every treatment and procedure efficiently, as well as honor the patient’s wishes (Rich, 2016, p. 39). Wit illustrates patient advocacy as Suzie, Vivian’s nurse, advocates for Vivian throughout the film. She preserves her dignity, works to protect her from further physical harm and side effects from her treatments, and implements her everyday needs. Additionally, Suzie secures Vivian’s wishes for a DNR status by encouraging documentation by Dr. Kelekian and firmly driving away Dr. Posner and the code team from beginning resuscitation efforts in the end scene. Patient advocacy involves keeping the patient’s needs at the forefront of planned interventions. This responsibility is especially true for a nurse, who addresses needs, wishes frequently a wellgoodaa teaching, and collaborates with the rest of the health care team for the best interests of the patient.
The nurse does not allow his or her values or opinions to reflect patient care; rather, he or she respects and carries out the patient’s wishes in an unbiased manner (Rich, 2016, p. 53). Through advocacy, the nurse can view and treat the patient holistically and as an individual (Rattani, 2015, para. 12). According to Tariman et. al, the main roles of an oncology nurse are to advocate, educate, and manage the side effects of cancer treatment (2016, p. 563). Another method of advocating is speaking up when there is a disagreement about treatment or when there are alternatives to the chosen action plan (Tariman et al., 2016, p. 563). These conflicts can arise between physicians and nurses, creating a shortage of influence on the nurses’ part and a morally unsatisfactory situation, in turn yielding moral distress (Hansen, Goodell, DeHaven & Smith, 2009, p. 263). Nurse Suzie in Wit may have been experiencing moral distress in her advocation for Vivian against Dr. Posner and Dr. Kelekian’s recommendations for treatment. Suzie disagreed with Vivian’s full dose of chemotherapy, the method of relief for Vivian’s severe pain, and the physicians’ aggressive interventions with Vivian. Moral suffering is common among nurses like Suzie that advocate for their patients and wishes to change the circumstances that generate such anguish; however, it is significant that nurses may learn to transform this distress into profound inner strength and wisdom (Rich, 2016, p. 54). Wit showcases elements of empathy that can offer relevant and useful information for practice. Vivian, coping with her new diagnosis, endures rigorous rounds of chemotherapy and radiation and withstands debilitating side effects as well as prolonged periods of hospitalization. Suzie, filling the role of confidant and empathetic nurse, observes and listens to Vivian’s anxiety, fears, and sadness associated with her progressing diagnosis and looming death. Dr. Posner, on the opposite hand, offers no solace to Vivian, informing her that he finds the pathology of cancer and research much more enjoyable than human interaction, which is the very thing Vivian craves. Other patients in real settings, much like Vivian in Wit, are devastated and overcome with complex emotions, confronting individualized stages over time and battles within themselves.
They may feel overwhelmed, fearful, and completely vulnerable, in addition to the multitude of physical symptoms, such as severe fatigue and relentless pain. Families of patients are profoundly affected as well and journey through similar coping periods; it is the critical responsibility of provider and nurse to provide empathy through these sensitive times for both patient and family (Lelorain, Brédart, Dolbeault & Sultan, 2012, p. 1255). Empathy involves both the mental ability to grasp the feelings, experiences and worries of the patient, as well as the skills to portray this understanding in a comforting and compassionate manner (Lelorain et al., 2012, p. 1262). Oncology nurses, specifically, fill a psychosocial support role for their patients in addition to other responsibilities that have been mentioned, such as advocacy, education, and medical management. Nurses should recall that the patient holds the most perspective regarding empathy and associated behaviors; inquiring about their responses to empathetic behaviors will likely be advantageous and informative, helping the nurse learn how to approach different situations in the future (Lelorain et al., 2012, pg. 1262). According to a study by Lelorain et al., there are numerous benefits to being empathetic towards patients; there is a marked reduction in both stress and the need for additional education, as well as higher rates of both psychosocial adaptation behaviors and patient satisfaction with staff and the overall healthcare experience (2012, p. 1257). Emotionally-intelligent behaviors positively affect parallel relationships between nurses, the nurse-patient relationship, and mental health for individual nurses; outcomes yielding from these behaviors include less burnout, effective coping in response to stress, greater communication between coworkers, and higher patient satisfaction, as well as theuphol upholerception of nurse compassion (Codier, Freitas & Muneno, 2013, p. 23). From an ethical standpoint, implementing clinical empathy for patients that upholds the concepts of beneficence, to do good, and non-maleficence, to avoid harm, can be viewed as part of a larger, necessary moral duty that should be implemented, regardless of studies that illustrate additional patient outcomes or benefits (Lelorain et al., 2012, p. 1262).
Wit opens several avenues of discourse regarding the concepts of mortality and end-of-life care. As the film advances, Vivian’s cancer advances with it, metastasizing and spreading despite her providers’ efforts. She bears chronic, severe pain along with a collection of other side effects; she exists in an incredibly vulnerable state with her intellectual pursuits and academic pride stripped away as she nears the end of her life. Suzie aims to make Vivian comfortable by helping to place her on a medication infusion to offer relief, as well as inquiring about Vivian’s code wishes. A good death, one that avoids suffering and preventable harm, is consistent with the principle of non-maleficence and is desirable in Vivian Bearing’s case as well as other patients who approach the end of life (Goldberg et. al, 2016, p. 1092; Rattani, 2015, para. 7). Care provider implementations and ethical duties include alleviating pain that is characteristic of progressing cancer diagnoses; pain is an excellent example of medical ethics and the principles of beneficence and non-maleficence (Rattani, 2015, para. 7). Further actions must be taken to ensure the patient transitions to palliative care with relative ease; it is also imperative to discuss the patient’s wants and needs for care or treatments, advanced care planning, and code status at the appropriate time, preferably before terminal illness, with patient and family members (Goldberg et al., 2016, p. 1092). Training staff to approach end-of-life discussions in an appropriate and timely manner, in addition to making these conversations a routine, will ensure that suffering is halted (Zhang et al., 2017, p. 288).
These specific discussions also guarantee determinationthethat th the discussions the o treatment trajectories and realistic expectations (Malayev, Levene, & Gonzalez, 2012, p. 516). Despite this advice, end-of-life talks are shown to happen only about 50% of the time, according to Zhang et al. (2017, p. 285). If providers fail to initiate these discussions, there is a drastically increased risk of invasive procedures such as resuscitation or ventilation, and lack of a acknowledgment fofprovidesor terminal illness and patient preferences (Goldberg et al., 2016, p. 1093; Zhang et al., 2017, p. 285). In addition, a lack of end-of-life communication results in astronomical medical and cancer care costs because life-extending measures lengthen past the point of patient desires and offer little benefit (Goldberg et al., 2016, p. 1093). These costs have multiple economic implications; a large percentage of Medicare expenditures are spent in the last month of life as hospital services add up (Goldberg et al., 2016, p. 1096) and 60% of cancer patients are shown to be admitted in the last month (Zhang et al., 2017, p. 285). In contrast to hospital care, palliative care is associated with reduced costs and positive outcomes for patients and their families, such as reduced risks of admission to the ICU, better quality of life, and decreased symptoms from treatment or manifestations of illness (Goldberg et al., 2016, p. 1096; Malayev et al., 2012, p. 515). According to MalayevofMalay et al., 70% of patients who received palliative care demonstrated an improvement in emotional function and pain control within 88 days (2012, p. 516). The film Wit is comprised of numerous and valuable indications for real-world practice in health care through particular themes such as autonomy, advocacy, empathy, and mortality. Health care professionals should allow Wit’s lessons to resonate and educate themselves about outcomes in scholarly research to guide them for the future. Ethical and legal implications should also be considered to provide high-quality care that is parallel to the patient’s wants and needs.